Crohn's esophagitis: a unique cause of esophageal polyposis

Abstract

Esophageal involvement in adults with Crohn's disease is uncommon. 1 McDonald GB Esophageal diseases caused by infection, systemic illness, medication and trauma. in: Textbook of gastrointestinal disease. WB Saunders, Philadelphia1993: 437 Google Scholar , 2 Geboes K Janssens J Rutgeerts P Vantrappen G Crohn's disease of the esophagus. J Clin Gastroenterol. 1986; 8: 31-37 Crossref PubMed Scopus (81) Google Scholar , 3 Fruhmorgen P Rosch W Endoskopischer Aspeckt des Morbus Crohn in Osophagus, Magen, Duodenum, Jejunum, Ileum und Kolon. Z Gastroenterol. 1974; 12: 592 PubMed Google Scholar , 4 Tishler JMA Helman CA Crohn's disease of the esophagus. J Can Assoc Radiol. 1984; 35: 28-30 PubMed Google Scholar , 5 Marshak RH Granulomatous disease of the intestinal tract (Crohn's disease). Radiology. 1975; 114: 3-22 PubMed Google Scholar The previously described endoscopic and radiologic abnormalities associated with Crohn's esophagitis include erythematous or friable mucosa, “cobblestone” mucosa, superficial aphthoid or “punched out” ulcers, deep ulcers, nodular masses, strictures, intramural sinus tracts, and fistulae. Cockey et al. 6 Cockey BM Jones B Bayless TM Shauer AB Filiform polyps of the esophagus with inflammatory bowel disease. AJR Am J Roentgenol. 1985; 144: 1207-1208 Crossref PubMed Scopus (17) Google Scholar reported a case of esophageal filiform polyposis in the setting of active esophageal Crohn's disease. We present a patient with multiple small esophageal polyps in the setting of active gastric, duodenal, and jejunal Crohn's disease. Pathologically, the polyps consisted of squamous hyperplasia with a predominant plasma cell infiltrate and small granulomas in the lamina propria. These lesions likely represent chronic active inflammatory changes of Crohn's disease. To our knowledge, this variant of esophageal involvement has not been reported and adds Crohn's disease to the differential diagnosis of esophageal polyps and polyposis.